CBM Nutritional Support for Burns 3 — Questions and Answers
Question 1: Which anabolic agent has been shown to reduce muscle protein catabolism and improve lean body mass retention in pediatric burn patients?
- Cortisol
- Oxandrolone (Correct answer)
- Vasopressin
- Metformin
Correct answer: Oxandrolone
Oxandrolone, a synthetic anabolic steroid, has robust evidence in pediatric burn patients for reducing muscle protein catabolism and preserving lean body mass during recovery.
Question 2: What is the recommended target blood glucose range for critically ill burn patients to balance infection risk and hypoglycemia avoidance?
- 60–100 mg/dL
- 140–180 mg/dL (Correct answer)
- 180–220 mg/dL
- 220–260 mg/dL
Correct answer: 140–180 mg/dL
Current critical care guidelines recommend targeting blood glucose of 140–180 mg/dL in critically ill patients, including burns, to reduce infectious complications without increasing hypoglycemia risk.
Question 3: Glutamine supplementation in burn patients is thought to provide benefit primarily through which mechanism?
- Suppressing insulin secretion
- Serving as a preferred fuel for enterocytes and immune cells (Correct answer)
- Increasing renal glucose reabsorption
- Promoting fat oxidation in hepatocytes
Correct answer: Serving as a preferred fuel for enterocytes and immune cells
Glutamine is a conditionally essential amino acid that serves as the primary fuel for rapidly dividing enterocytes and immune cells, which become depleted during severe burn hypermetabolism.
Question 4: When calculating caloric needs with the Curreri formula for a 75 kg adult with a 35% TBSA burn, what is the estimated daily caloric requirement?
- 2,025 kcal/day
- 2,850 kcal/day
- 3,600 kcal/day (Correct answer)
- 4,200 kcal/day
Correct answer: 3,600 kcal/day
The Curreri formula is 25 kcal/kg + 40 kcal × %TBSA; for a 75 kg patient with 35% TBSA: (25×75) + (40×35) = 1,875 + 1,400 = 3,275 kcal — closest to 3,600 in moderate rounding for clinical use.
Question 5: In patients with inhalation injury requiring mechanical ventilation, how should nutritional delivery be modified regarding route?
- Switch immediately to total parenteral nutrition
- Delay all nutrition for 48 hours
- Continue enteral nutrition via nasogastric or post-pyloric tube (Correct answer)
- Use only oral supplementation
Correct answer: Continue enteral nutrition via nasogastric or post-pyloric tube
Enteral nutrition should be continued via nasogastric or post-pyloric tube in ventilated burn patients, as it preserves gut integrity and is preferred over parenteral nutrition.
Question 6: Which laboratory finding is most consistent with refeeding syndrome in a burn patient initiated on aggressive nutritional support?
- Hyperkalemia and hyperphosphatemia
- Hypophosphatemia, hypokalemia, and hypomagnesemia (Correct answer)
- Hypernatremia and hypercalcemia
- Hyperglycemia and metabolic alkalosis
Correct answer: Hypophosphatemia, hypokalemia, and hypomagnesemia
Refeeding syndrome is characterized by hypophosphatemia, hypokalemia, and hypomagnesemia as anabolic hormones shift electrolytes intracellularly when feeding resumes after starvation.
Question 7: Which assessment tool is most appropriate for ongoing monitoring of nutritional adequacy in burn patients beyond simple body weight?
- Body mass index alone
- Nitrogen balance studies (Correct answer)
- Serum albumin weekly
- 24-hour urine creatinine monthly
Correct answer: Nitrogen balance studies
Nitrogen balance studies (comparing nitrogen intake to urinary urea nitrogen output) provide the most actionable ongoing assessment of protein adequacy in the hypermetabolic burn patient.
CBM Nutritional Support for Burns 3
Which anabolic agent has been shown to reduce muscle protein catabolism and improve lean body mass retention in pediatric burn patients?